Intramedullary rod plate system

ABSTRACT

A system to stabilize a fracture includes an intramedullary rod having a first end and a second end and configured for placement within a medullary bone canal of a bone. The intramedullary rod includes a first rod hole at the second end. The system also includes an intramedullary rod plate having a first plate hole and a second plate hole. The system also includes a first fastener configured to be received by the first plate hole, wherein the first fastener passes through an outer surface of the bone and through the first rod hole at the second end of the intramedullary rod such that the first fastener secures the intramedullary rod plate to the intramedullary rod. The system further includes a second fastener configured to pass through the second plate hole and into the bone such that the second fastener secures the intramedullary rod plate to the bone.

BACKGROUND

The following description is provided to assist the understanding of thereader. None of the information provided or references cited is admittedto be prior art.

Fractures or other conditions that cause instability of a long bone maybe stabilized with intramedullary rod fixation, or otherwise known asintramedullary nail fixation. In this type of fixation procedure, animplant such as an intramedullary rod or nail is inserted through eitherthe proximal or distal end of a long bone into the medullary canal. Therod diameter is chosen to be slightly smaller than the diameter of themedullary canal, such that the rod can be passed along the length of thelong bone, while still providing a frictional interference fit betweenthe outer surface of the rod and the surface of the medullary canal. Therod is passed across the fracture (or other area of bony instability,but for purposes of brevity, will henceforth be referenced as afracture), and due to the rod frictional interference fit of the rodwith the medullary canal of the bone both proximal and distal to thefracture, some degree of stability is restored.

SUMMARY

An illustrative system to stabilize a fracture includes anintramedullary rod having a first end and a second end and configuredfor placement within a medullary bone canal of a bone. Theintramedullary rod includes a first rod hole at the second end. Thesystem also includes an intramedullary rod plate having a first platehole and a second plate hole. The system also includes a first fastenerconfigured to be received by the first plate hole, wherein the firstfastener passes through an outer surface of the bone and through thefirst rod hole at the second end of the intramedullary rod such that thefirst fastener secures the intramedullary rod plate to theintramedullary rod. The system further includes a second fastenerconfigured to pass through the second plate hole and into the bone suchthat the second fastener secures the intramedullary rod plate to thebone.

An illustrative method to stabilize a fracture includes placing anintramedullary rod having a first end and a second end into a medullarybone canal of a bone, where the intramedullary rod includes a first rodhole at the second end. The method also includes placing anintramedullary rod plate proximate to the second end of theintramedullary rod, where the intramedullary rod plate includes a firstplate hole and a second plate hole. The method also includes placing afirst fastener in contact with the first plate hole, through an outersurface of the bone, and through the first rod hole at the second end ofthe intramedullary rod to secure the intramedullary rod plate to theintramedullary rod. The method further comprises placing a secondfastener through the second plate hole and into the bone to secure theintramedullary rod plate to the bone.

The foregoing summary is illustrative only and is not intended to be inany way limiting. In addition to the illustrative aspects, embodiments,and features described above, further aspects, embodiments, and featureswill become apparent by reference to the following drawings and thedetailed description.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a top or anterior view depicting an intramedullary rod afterinsertion into a femur, with an interlocking blade fastener insertedthrough the distal end of the femur and through the rod, and theintramedullary rod plate being attached to the blade fastener, inaccordance with an illustrative embodiment. The intramedullary rod plateis attached to the interlocking blade fastener, and plate screws havebeen inserted into the distal end of the femur through holes in theintramedullary rod plate, thus securing the intramedullary rod plate tothe distal end of the femur.

FIG. 1B is a side or lateral view depicting an intramedullary rod afterinsertion into a femur, with an interlocking blade fastener insertedthrough the distal end of the femur and through the rod, and theintramedullary rod plate being attached to the blade fastener, inaccordance with an illustrative embodiment. The intramedullary rod plateis attached to the interlocking blade fastener, and plate screws havebeen inserted into the distal end of the femur through holes in theintramedullary rod plate, thus securing the intramedullary rod plate tothe distal end of the femur.

FIG. 2A is a top view depicting an intramedullary rod, interlockingblade, intramedullary rod plate, plate securing device, and plate screwsin an assembling position, in accordance with illustrative embodiments.

FIG. 2B is a close-up top view depicting an interlocking blade,intramedullary rod plate, plate securing device, and plate screws, inaccordance with illustrative embodiments.

FIG. 3A is a top view depicting one end of an intramedullary rod, withthe interlocking blade, intramedullary rod plate, plate securing device,and plate screws in an assembling position, in accordance withillustrative embodiments.

FIG. 3B is a top view depicting the interlocking blade inserted into theintramedullary rod, with the intramedullary rod plate, plate securingdevice, and plate screws in an assembling position, in accordance withillustrative embodiments.

FIG. 3C is a top view depicting the intramedullary rod plate placed ontothe interlocking blade that has been inserted into the intramedullaryrod, with the plate securing device and plate screws in an assemblingposition, in accordance with illustrative embodiments.

FIG. 3D is a top view depicting the plate securing device now securingthe intramedullary rod plate to the interlocking blade that has beeninserted into the intramedullary rod, with plate screws in an assemblingposition, in accordance with illustrative embodiments.

FIG. 3E is a top assembled view depicting the intramedullary rod platesecured to the interlocking blade that has been inserted into theintramedullary rod, in accordance with illustrative embodiments.

FIG. 4A is a perspective view depicting the interlocking blade,intramedullary rod plate, and plate securing device in an assemblyposition, in accordance with illustrative embodiments.

FIG. 4B is a perspective view depicting the intramedullary rod plateplaced on the interlocking blade, with the plate securing device in anassembly position, in accordance with illustrative embodiments.

FIG. 4C is a perspective view depicting the assembled intramedullary rodplate secured to the interlocking blade with the plate securing device,in accordance with an illustrative embodiment.

FIG. 5A is a perspective view depicting the interlocking blade,intramedullary rod plate, and plate securing device in an assemblyposition, in accordance with illustrative embodiments.

FIG. 5B is a perspective view depicting the intramedullary rod plateplaced on the interlocking blade, in accordance with an illustrativeembodiment.

FIG. 6A is a first perspective view depicting the assembledintramedullary rod plate secured to the interlocking blade that has beeninserted into the intramedullary rod, with plate screws placed throughthe intramedullary rod plate, in accordance with an illustrativeembodiment.

FIG. 6B is a second perspective view depicting the assembledintramedullary rod plate secured to the interlocking blade that has beeninserted into the intramedullary rod, with plate screws placed throughthe intramedullary rod plate, in accordance with an illustrativeembodiment.

FIG. 6C is a third perspective view depicting the assembledintramedullary rod plate secured to the interlocking blade that has beeninserted into the intramedullary rod, with plate screws placed throughthe intramedullary rod plate, in accordance with an illustrativeembodiment.

FIG. 7A is an end view depicting the assembled intramedullary rod platesecured to the interlocking blade that has been inserted into theintramedullary rod, in accordance with an illustrative embodiment.

FIG. 7B is a side or lateral view depicting the assembled intramedullaryrod plate with the plate securing device that attaches theintramedullary rod plate to the interlocking blade that has beeninserted into the intramedullary rod, in accordance with an illustrativeembodiment.

FIG. 8A is a top or anterior view depicting an intramedullary rod afterinsertion into a femur, with an interlocking bolt fastener insertedthrough the lateral aspect of the distal end of the femur and into therod, and the intramedullary rod plate being attached to the boltfastener, in accordance with an illustrative embodiment. Theintramedullary rod plate is attached to the interlocking bolt fastener,and plate screws have been inserted into the distal end of the femurthrough holes in the intramedullary rod plate, thus securing theintramedullary rod plate to the distal end of the femur.

FIG. 8B is a side or lateral view depicting an intramedullary rod afterinsertion into a femur, with an interlocking bolt fastener (not shown)inserted through the lateral aspect of the distal end of the femur andinto the rod, and the intramedullary rod plate is attached to the boltfastener (not shown), in accordance with an illustrative embodiment. Theintramedullary rod plate is attached to the interlocking bolt fastener(not shown) with the plate securing device, and plate screws have beeninserted into the distal end of the femur through holes in theintramedullary rod plate, thus securing the intramedullary rod plate tothe distal end of the femur. In this depiction, the terminal ends of theplate screws are not visualized because they are depicted as having beenplaced perpendicular to the lateral plate surface, thus hidden from viewby the plate when viewed from the side.

FIG. 8C is a side or lateral view depicting an intramedullary rod afterinsertion into a femur, with an interlocking bolt fastener (not shown)inserted through the lateral aspect of the distal end of the femur andinto the rod, and the intramedullary rod plate is attached to the boltfastener (not shown), in accordance with an illustrative embodiment. Theintramedullary rod plate is attached to the interlocking bolt fastener(not shown) with the plate securing device, and plate screws have beeninserted into the distal end of the femur through holes in theintramedullary rod plate, thus securing the intramedullary rod plate tothe distal end of the femur. In this depiction, the terminal ends of theplate screws are visualized because they are depicted as having beenplaced obliquely to the lateral plate surface, divergent from the longaxis of the intramedullary rod.

FIG. 9A is a perspective view depicting the assembled intramedullary rodplate secured to the interlocking bolt that has been inserted into theintramedullary rod, with plate screws placed through the intramedullaryrod plate, in accordance with an illustrative embodiment.

FIG. 9B is a perspective view depicting the interlocking bolt,intramedullary rod plate, and plate securing device in an assemblyposition, in accordance with an illustrative embodiment.

FIG. 9C is a perspective view depicting the assembled intramedullary rodplate secured to the interlocking bolt with the plate securing device,in accordance with an illustrative embodiment.

FIG. 9D is a perspective view depicting the interlocking bolt,intramedullary rod plate, and plate securing device in an assemblyposition, in accordance with illustrative embodiments.

FIG. 9E is a perspective view depicting the assembled intramedullary rodplate seated on the interlocking bolt, in accordance with anillustrative embodiment.

FIG. 10A is a perspective view depicting one end of an intramedullaryrod, with interlocking bolt, intramedullary rod plate, plate securingdevice, and plate screws in an assembling position, in accordance withillustrative embodiments.

FIG. 10B is a perspective view depicting the interlocking bolt insertedinto the intramedullary rod, with the intramedullary rod plate, platesecuring device, and plate screws in an assembling position, inaccordance with illustrative embodiments.

FIG. 10C is a perspective view depicting the intramedullary rod plateplaced onto the interlocking bolt that has been inserted into theintramedullary rod, with the plate securing device and plate screws inan assembling position, in accordance with illustrative embodiments.

FIG. 10D is a perspective view depicting the plate securing device nowsecuring the intramedullary rod plate to the interlocking bolt that hasbeen inserted into the intramedullary rod, with plate screws in anassembling position, in accordance with illustrative embodiments.

FIG. 11A is a perspective view depicting the assembled plate securingdevice securing the intramedullary rod plate to the interlocking boltthat has been inserted into the intramedullary rod, with plate screwsinserted through the intramedullary rod plate, in accordance with anillustrative embodiment.

FIG. 11B is an end view depicting the assembled intramedullary rod platesecured to the interlocking bolt that has been inserted into theintramedullary rod, with plate screws inserted through theintramedullary rod plate, in accordance with an illustrative embodiment.

FIG. 11C is a top view depicting the assembled plate securing devicesecuring the intramedullary rod plate to the interlocking bolt that hasbeen inserted into the intramedullary rod, with plate screws insertedthrough the intramedullary rod plate, in accordance with an illustrativeembodiment.

FIG. 12A is a perspective view depicting an intramedullary rod, withinterlocking screw, intramedullary rod plate, and plate screws in anassembling position, in accordance with illustrative embodiments.

FIG. 12B is a perspective view depicting an interlocking screw passedthrough the intramedullary rod plate and the intramedullary rod, withplate screws in an assembling position, in accordance with illustrativeembodiments.

FIG. 12C is a perspective view depicting an assembled interlocking screwpassed through the intramedullary rod plate and the intramedullary rod,with plate screws passed through the intramedullary rod plate, inaccordance with an illustrative embodiment.

FIG. 13A is a top view depicting an assembled interlocking screw passedthrough the intramedullary rod plate and the intramedullary rod, withplate screws passed through the intramedullary rod plate, in accordancewith an illustrative embodiment.

FIG. 13B is a top perspective view depicting an assembled interlockingscrew passed through the intramedullary rod plate and the intramedullaryrod, with plate screws passed through the intramedullary rod plate, inaccordance with an illustrative embodiment.

FIG. 14A is an end perspective view depicting an assembled interlockingscrew passed through the intramedullary rod plate and the intramedullaryrod, with plate screws passed through the intramedullary rod plate, inaccordance with an illustrative embodiment.

FIG. 14B is a perspective view depicting an assembled interlocking screwpassed through the intramedullary rod plate and the intramedullary rod,with plate screws passed through the intramedullary rod plate, inaccordance with an illustrative embodiment.

FIG. 15 is a flow diagram depicting operations performed to use anintramedullary rod plate system in accordance with an illustrativeembodiment.

The foregoing and other features of the present disclosure will becomeapparent from the following description and appended claims, taken inconjunction with the accompanying drawings. Understanding that thesedrawings depict only several embodiments in accordance with thedisclosure and are, therefore, not to be considered limiting of itsscope, the disclosure will be described with additional specificity anddetail through use of the accompanying drawings.

DETAILED DESCRIPTION

In the following detailed description, reference is made to theaccompanying drawings, which form a part hereof. In the drawings,similar symbols typically identify similar components, unless contextdictates otherwise. The illustrative embodiments described in thedetailed description, drawings, and claims are not meant to be limiting.Other embodiments may be utilized, and other changes may be made,without departing from the spirit or scope of the subject matterpresented here. It will be readily understood that the aspects of thepresent disclosure, as generally described herein, and illustrated inthe figures, can be arranged, substituted, combined, and designed in awide variety of different configurations, all of which are explicitlycontemplated and make part of this disclosure.

Intramedullary rod (alternatively called intramedullary nail) fixationof a long bone involves an intramedullary device and a method to insertthe intramedullary device into the intramedullary canal of the longbone. The intramedullary rod is usually cylindrical but may have slotsor grooves on the outer surface, depending on the design. In humans andanimals, an intramedullary rod is commonly used to treat fractures (orother causes of instability such as tumors, infections, etc.,) in a longbone, which in humans is most commonly the femur and tibia, but can alsoinclude the humerus, ulna, radius, and fibula. The intramedullary rodpartially achieves stability by virtue of its frictional fit within thecancellous metaphyseal bone at one or both ends of the bone beingtreated, and within the medullary canal of the long bone proximal anddistal to the fracture site. This stability can be augmented by passinginterlocking screws, blades, or other fasteners from one bone surfacethrough a reciprocal hole or holes in the intramedullary rod and out theopposite bone surface. These interlocking fasteners improve stability byfurther securing the intramedullary rod to the bone, but they depend onsufficient bone quantity and quality being present in the interlockingfastener zone, which typically is located at the terminal ends of therod. In addition, the interlocking fasteners must pass through theintramedullary rod, further limiting the fixation options. This istypically not a problem when the fracture is located in the centraldiaphyseal bone region. However, when the fracture is located towardsthe proximal or distal end of the bone, the fixation options may bequite limited, in part because the surgeon must pass the interlockingfasteners through holes of the intramedullary rod that are located in afixed position. The fixation options are particularly limiting inpatients with compromised bone quality, such as in patients withosteopenia or osteoporosis.

Another scenario that poses problems with adequate interlocking fastenerfixation is in patients who sustain periprosthetic fractures, especiallyin fractures that occur adjacent to a total knee arthroplasty, and infractures near a joint (peri-articular) because the amount of bonepresent for interlocking fastener fixation may be minimal. Even whensome bone is present in peri-articular fractures or fractures near atotal knee prosthesis, the surgeon may not be able to achieveinterlocking fastener fixation in this bone because the interlockingfastener trajectory is dictated by the location of the reciprocalinterlocking fastener holes in the intramedullary rod. In these cases,interlocking fixation options can be limited or not possible, andintramedullary rod-assisted fixation of such fractures may be extremelydifficult or not feasible. In such situations, even when anintramedullary rod-assisted fixation operation is performed, it may beprone to mechanical failure.

Depending on the fracture configuration, intramedullary rod fixation maynot be appropriate or even possible, in which case, a plate is oftenused to fix the fracture because of the wider array of fixation optionsat the terminal end of the plate. When a plate is used, the incision(s)used to place the plate is/are usually substantially longer than theincision(s) used to place an intramedullary rod. The plate is placed onan outer surface of the fractured bone, and screws are placed throughholes in the plate both proximal and distal to the fracture site in aconfiguration that secures the plate to the bone and in so doingachieves stability across the fracture site. One advantage to a platewhen compared to an intramedullary rod is the wider array of fixationoptions at the terminal end of the plate, because the screws that areplaced through the plate can be oriented in a variety of directions inorder to achieve bony purchase, without the limitation of needing topass through an intramedullary rod in order to achieve stability. Onedisadvantage of a plate when compared to an intramedullary rod is thegreater degree of soft tissue disruption necessary to place the plate onthe bone surface, which requires longer and more incisions, and disruptsmuscle attachments thereby risking injury to neurovascular structures.

The present disclosure overcomes at least some of the disadvantages ofexisting intramedullary rod devices and methods, and existing platedevices and methods. Specifically, the surgical system of the presentdisclosure provides the advantages of intramedullary rod systems and theadvantages of plate systems to maximize fixation options, while negatingthe disadvantages of these respective fracture fixation options. Withthe system of the present disclosure, bony fixation occurs on one sideof the fracture with interlocking fasteners placed outside theintramedullary rod through an intramedullary rod plate that has alimited plate footprint compared to a conventional plate, with thefixation force achieved through the intramedullary rod plate transferredto the intramedullary rod at one end of the rod. Fixation on the otherside of the fracture occurs with the intramedullary rod and interlockingfasteners in a conventional manner. The plate footprint is very muchlimited compared to a conventional plate fixation construct, because thedisclosed intramedullary rod plate achieves fixation on only one side ofthe fracture, whereas a conventional plate must span the fracture sitein order to achieve fixation on both sides of the fracture. Theintramedullary rod plate system described herein allows for fixation onone side of the fracture with a plate and associated fasteners, andfixation on the other side of the fracture with the intramedullary rodand associated fasteners, thus maximizing the advantages and minimizingthe disadvantages of conventional intramedullary rod and plate systems.

In particular, the intramedullary rod plate system of the presentdisclosure includes an intramedullary rod plate that attaches to aninterlocking fastener that is connected to the intramedullary rod, andscrews that pass through the intramedullary rod plate in order toachieve bony fixation outside the rod. Fixation is achieved on one sideof the fracture primarily by virtue of the intramedullary rod'sfrictional fit within the medullary bone canal, whereas fixation isachieved on the other side of the fracture by virtue of theintramedullary rod plate (and associated screws) that is attached to theinterlocking fastener that is in turn attached to the intramedullaryrod. The intramedullary rod plate is much smaller than a conventionalplate, because the plate itself need not cross the fracture site.Instead, the intramedullary rod plate is held in position by itsattachment to the intramedullary rod, which then allows the surgeon topass screws in a variety of trajectories through holes in theintramedullary rod plate and into available bone in order to achievefixation. Placement of the intramedullary rod plate requires smaller andfewer incisions and less soft tissue disruption than placing aconventional plate.

By virtue of using the surgical system of the present disclosure, theintramedullary rod plate system may be used to treat such conditionssuch as, for example, peri-articular, peri-prosthetic, metaphyseal, anddiaphyseal fractures of the femur, tibia, humerus, fibula, radius,clavicle, and ulna. The intramedullary rod plate system may also be usedto achieve stability in the aforementioned long bones due to conditionssuch as tumor and infection. The intramedullary rod plate system may beemployed for surgical treatments in a patient in a lateral, supine,oblique, or prone position, and may employ various approaches to thebones being treated. The intramedullary rod plate system may be used, inaddition to humans, on animals, bone models, and other non-viablesubstrates, for example, for use in testing, demonstration, andtraining.

Referring now to FIG. 1A, a top or anterior view depicting anintramedullary rod plate system in an assembled position afterretrograde insertion of an intramedullary rod 100 into theintramedullary canal of a femur 105 in order to stabilize distal femurmetaphyseal fracture 106 is shown, in accordance with an illustrativeembodiment. A human femur bone is used as an example henceforth, butshould not be considered limiting with respect to application of theintramedullary rod plate system to other bones and other non-viablesubstrates. For example, the systems described herein can be used onother types of bone fractures such as tibia fractures, humerusfractures, etc. in humans or animals. Additionally, several of theembodiments herein are described with reference to a distal fracture.However, it should be understood that the systems of the presentapplication can also be used on proximal fractures. The intramedullaryrod plate system includes an intramedullary rod plate 150, plate bonescrew fasteners 160, and a plate securing device 155 (partially shown)that secures the intramedullary rod plate 150 to an interlocking bladefastener 175 (henceforth referred to as an interlocking blade 175). Insome embodiments, four plate bone screw fasteners 160 (henceforthreferred to as plate screw(s) 160) are used. It is noted that only twoplate screws are fully visible in FIG. 1A because in this top view thetwo plate screws closest to the viewer overlap the two plate screws mostdistant from the viewer. In alternative embodiments, additional or fewerplate screws may be used. The plate screws 160 are inserted through theintramedullary rod plate 150 and into femoral bone distal to fracture106. Fracture fixation distal to the fracture occurs by transferring thebone fixation force achieved with screws 160 (that are inserted intodistal femur bone) to the intramedullary rod plate 150, which in turntransfers this force to intramedullary rod 100 through the attachment ofinterlocking blade 175 to both the intramedullary rod plate 150 and theintramedullary rod 100. Interlocking blade 175 also may have aninterference fit with distal femur bone, further conferring fixationdistal to fracture 106.

Conventional intramedullary rod fixation of this type of distal femurfracture, as well as peri-articular and peri-prosthetic fractures,depends primarily on an interlocking blade or other fixation implementsuch as a screw to achieve fixation within distal femur bone on one orboth sides of an intramedullary rod. In such conventional systems,interlocking fastener fixation is achieved with a frictional fit of theinterlocking blade or interlocking screw(s) with distal femur bone onone or preferably both sides of the intramedullary rod. The interlockingfastener fixation force is transferred to the rod by virtue of theinterlocking fastener either fitting with minimal tolerance through thehole in the intramedullary rod, or by virtue of a locking screw orfastener that is passed through the opening in the center of thecannulated intramedullary rod and engaged with the interlockingfastener. Therefore, the amount of fixation force achievable with aconventional intramedullary rod system is limited by the necessarypassing of the interlocking fastener through a hole in theintramedullary rod. Even when multiple interlocking fasteners are used,they all must pass through holes in the intramedullary rod in order toprovide stability.

The intramedullary rod plate system described herein allows for fixationoutside the intramedullary rod, thus greatly expanding the fixationoptions because the surgeon no longer is limited by a requirement topass all interlocking fasteners through the intramedullary rod. Instead,one interlocking fastener (or in alternative embodiments, two or morefasteners) is passed through the rod, with the primary purpose ofproviding a connection from the intramedullary rod to the intramedullaryrod plate. The surgeon can then pass screws or other fasteners throughholes in the intramedullary rod plate using a variety of trajectoriesaimed at available bone for fixation. Whereas in some embodiments theinterlocking fastener that is passed through the intramedullary rod mayalso provide some stability via a frictional fit with surrounding boneas with a conventional intramedullary rod system, the primary purpose ofthe interlocking fastener used in the intramedullary rod plate system isto create a connection between the intramedullary rod located inside thebone and the intramedullary rod plate located on a surface of the bone.

Referring again to FIG. 1A, intramedullary rod fixation proximal to thefracture occurs via the frictional fit of the outer surface of theintramedullary rod 100 to the surface of the medullary canal of femur105, and this proximal fixation may be augmented by placing one or moreinterlocking screws 165 (in some embodiments, comprised of threadedshaft portion 166 and head portion 167) or other fasteners through bonelocated towards the proximal end of the femur and through a hole orholes in the intramedullary rod 100 at the end of the intramedullary rodopposite the end of the rod with interlocking blade 175, in a mannerknown to those schooled in the art.

Referring now to FIG. 1B in conjunction with FIG. 1A, a side or lateralview depicting an intramedullary rod plate system in an assembledposition after retrograde insertion of an intramedullary rod 100 intothe intramedullary canal of the femur 105 in order to stabilize distalfemur fracture 106 is shown, in accordance with an illustrativeembodiment. Retrograde insertion of the intramedullary rod insertion isperformed through a hole drilled in the distal end of the femur, i.e.,the knee, and the intramedullary rod is passed from the hole drilled inthe distal end of the femur into the intramedullary canal and towardsthe hip, in a manner known to those schooled in the art. Intramedullaryrod plate 150 is secured to the interlocking blade 175 by plate securingdevice 155, the head 157 of which is visible in FIG. 1B. It is notedthat the interlocking blade 175 is not visible in FIG. 1B as it iscovered by the intramedullary rod plate 150. In some embodiments,intramedullary rod plate 150 can include four holes to accommodate fourplate screws 160 (not shown, plate screw heads 162 are shown here,representing plate screws 160 as seen in FIG. 1A). In alternativeembodiments, intramedullary rod plate 150 can include more or fewerholes and can thus be used with more or fewer than four plate screws160. In some embodiments, intramedullary rod plate 150 may bepre-contoured or contoured intra-operatively to closely match the localbony anatomy.

Intramedullary rod fixation proximal to the fracture occurs via thefrictional fit of the outer surface of the intramedullary rod 100 to thesurface of the medullary canal of femur 105, and this proximal fixationmay be augmented by placing one or more interlocking screws 165 (asrepresented in this view by interlocking screw head 167) or fastenersthrough bone located towards the proximal end of the femur and through ahole or holes in the intramedullary rod 100 at the end of theintramedullary rod opposite the end of the rod with interlocking blade175 (e.g., proximal interlocking screws), in a manner known to thoseschooled in the art.

The directions anterior-posterior, proximal-distal, and medial-lateralare well understood terms to people of skill in the art. For example, ananterior-posterior direction may refer to a horizontal, substantiallyhorizontal, front-back, or back-front direction (e.g., the knee cap orpatella is the anterior aspect of a human knee, and the skin crease onthe back of the knee is the posterior aspect of a human knee), while amedial-lateral direction may refer to a horizontal, substantiallyhorizontal, left-right, or right-left direction (e.g., left hand-righthand or right hand-left hand direction of a human body). Similarly, aproximal-distal direction or a superior-inferior direction may refer toa vertical, substantially vertical, top-bottom, or bottom-top direction(e.g., head-toe or toe-head direction of the human body, whereby the hipis the proximal part of the femur and the knee is the distal part of thefemur).

Referring now to FIG. 2A, a top view depicting an intramedullary rod100, interlocking blade 175, intramedullary rod plate 150, platesecuring device 155, and plate screws 160 in an assembling position areshown, in accordance with illustrative embodiments. FIG. 2B is aclose-up top view depicting interlocking blade 175, intramedullary rodplate 150, plate securing device 155, and plate screws 160, inaccordance with illustrative embodiments. In some embodiments,interlocking blade 175 includes a blade portion 176 that is designed topass with minimal tolerance (thus providing some degree of frictionalfit with the intramedullary rod) through a hole in the intramedullaryrod and achieve bone fixation via a frictional interaction of the bladewith surrounding bone. The interlocking blade 175 is attached to theintramedullary rod 100 via a frictional fit and/or via a bolt or otherfastener that is configured to pass through one end of the rod andengage the interlocking blade 175. In some embodiments, interlockingblade 175 includes a blade head portion 177 that may be configured toattach to an insertion tool for use during insertion. The blade headportion 177 also serves the purpose of being a method of attachment tointramedullary rod plate 150 by fitting within a cylindrical receivingpart 152 of the intramedullary rod plate 150. The attachment ofintramedullary rod plate 150 to interlocking blade 175 is discussed inmore detail with reference to FIGS. 4A-4C.

In some embodiments, plate fastener 155 includes a threaded shaftportion 156 that threads into a reciprocal threaded portion in bladehead portion 177, as depicted in FIGS. 4A and 4B. Plate fastener 155also includes a head portion 157. In some embodiments, intramedullaryrod plate 150 includes two or more holes 151 to accommodate plate screws160. In some embodiments, plate screws 160 include a threaded portion161 that enables frictional fixation with bone, and a head portion 162configured to attach to a screwdriver or other insertion device duringscrew insertion. In an illustrative embodiment, the head portion 162serves the purpose of attaching to intramedullary rod plate 150 bypressing tightly into screw holes 151 during fracture fixation, creatinga frictional fit. In some embodiments, the portion of plate screw head162 that engages with intramedullary rod plate screw holes 151 may beconfigured with threads, with reciprocal threads configured in screwholes 151, in order to create a secure locked attachment between platescrews 160 and intramedullary rod plate 150 via the screw threads.

FIGS. 3A-3E depict the assembly sequence of an embodiment of theintramedullary rod plate system in accordance with an illustrativeembodiment. Now turning to FIG. 3A, a top view depicting one end ofintramedullary rod 100, with interlocking blade 175, intramedullary rodplate 150, plate securing device 155, and plate screws 160 are shown inan assembling position, in accordance with illustrative embodiments.Intramedullary rod 100 includes a hole 101 (partially shown) thataccommodates interlocking blade 175.

Now turning to FIG. 3B, a top view depicting one end of intramedullaryrod 100 now with interlocking blade 175 inserted through hole 101 (fromFIG. 3A) is shown, in accordance with an illustrative embodiment.Interlocking blade 175 includes a head portion 177, as shown in FIG. 2B.Intramedullary rod plate 150, plate securing device 155, and platescrews 160 are shown in an assembling position, in accordance withillustrative embodiments.

Now turning to FIG. 3C, a top view depicting one end of intramedullaryrod 100 with interlocking blade 175 inserted through hole 101 (from FIG.3A), now with intramedullary rod plate 150 placed onto blade headportion 177 (from FIG. 3B) is shown, in accordance with an illustrativeembodiment. Plate securing device 155 and plate screws 160 are shown inan assembling position, in accordance with illustrative embodiments.

Now turning to FIG. 3D, a top view depicting one end of intramedullaryrod 100 with interlocking blade 175 inserted through hole 101 (from FIG.3A) and intramedullary rod plate 150 placed onto blade head portion 177(from FIG. 3B) is shown, in accordance with an illustrative embodiment.In FIG. 3D, the plate securing device 155 is shown securing interlockingblade 175 to intramedullary rod plate 150. It is noted that only theplate securing device head 157 is visible because it has been insertedinto interlocking blade 175, a process that is illustrated withreference to FIGS. 4A-4C. Plate screws 160 are shown in an assemblingposition, in accordance with an illustrative embodiment. FIGS. 4A-4C andFIGS. 5A-5B further depict the interaction amongst interlocking blade175, intramedullary rod plate 150, and plate securing device 155.

Now turning to FIG. 3E, a top view depicting an assembled intramedullaryrod plate system is shown in accordance with an illustrative embodiment.The interlocking blade 175 is inserted through hole 101 (from FIG. 3A)in one end of intramedullary rod 100 and intramedullary rod plate 150 isplaced onto blade head portion 177 (from FIG. 3B) of interlocking blade175. The plate securing device 155 (only the plate securing device head157 is visible) secures the interlocking blade 175 to intramedullary rodplate 150, now with plate screws 160 passed through intramedullary rodplate 150.

FIGS. 4A-4C and FIGS. 5A-5B depict the assembly of interlocking blade175 with intramedullary rod plate 150, in accordance with illustrativeembodiments. FIGS. 4A-4C are views showing the lateral aspect, and FIGS.5A-5B are views showing the medial aspect, of intramedullary rod plate150. Turning now to FIG. 4A, a perspective view depicting interlockingblade 175, intramedullary rod plate 150, and plate securing device 155in an assembly position is shown, in accordance with illustrativeembodiments. In some embodiments, interlocking blade 175 includes a headportion 177 with a central threaded hole 178. Threaded hole 178 faceslaterally and can accommodate and mate with the threaded shaft portion156 of plate securing device 155. In some embodiments, intramedullaryrod plate 150 includes four holes 151 that can accommodate plate screws(160, shown in FIG. 2B). In alternative embodiments, intramedullary rodplate 150 can include fewer or more than four holes 151 that canaccommodate plate screws 160 or other fasteners. In some embodiments,intramedullary rod plate 150 can include a central cylindrical receivingpart 152 (partially shown here, also shown in FIG. 2B, and later shownin FIG. 5A) that accommodates head portion 177 of interlocking blade 175on the medial side of the plate. The intramedullary rod plate alsoincludes a central plate hole 154 that allows for passage of threadedshaft portion 156 of plate fastener 155 through intramedullary rod plate150 into threaded portion 178 of interlocking blade 175. In someembodiments, central hole 154 can include a side wall 153 that facessubstantially lateral and accommodates the medial plate-facing surfaceof plate securing device head 157 of plate securing device 155. Therelationship of these elements is further depicted in FIGS. 4B-4C.

Now turning to FIG. 4B, a perspective view depicting intramedullary rodplate 150 seated on interlocking blade 175, with plate securing device155 in an assembly position is shown, in accordance with illustrativeembodiments. Threaded hole 178 (see also FIG. 4A) of interlocking blade175 is visible through central plate hole 154 and in some embodiments isconfigured to mate with the threaded shaft portion 156 of plate securingdevice 155.

Now turning to FIG. 4C, a perspective assembled view depictingintramedullary rod plate 150 secured to interlocking blade 175 withplate securing device 155 is shown, in accordance with an illustrativeembodiment. In FIG. 4C, only the plate securing device head 157 isvisible because the threaded shaft portion 156 from FIGS. 4A and 4B hasbeen inserted into threaded hole 178 from FIGS. 4A and 4B.

Turning now to FIG. 5A, a perspective view depicting interlocking blade175, intramedullary rod plate 150, and plate securing device 155 in anassembly position is shown, in accordance with illustrative embodiments.In some embodiments, interlocking blade 175 can include a head portion177, with a central threaded hole 178 (not shown here, shown in FIGS. 4Aand 4B) that accepts and mates with the threaded shaft portion 156 ofplate securing device 155. In some embodiments, intramedullary rod plate150 includes four holes 151 that can accommodate plate screws 160 (fromFIG. 2B) or other fasteners. In alternative embodiments, intramedullaryrod plate 150 can include fewer or more than four holes 151 that canaccommodate plate screws 160 (from FIG. 2B) or other fasteners. In someembodiments, intramedullary rod plate 150 includes a central cylindricalreceiving part 152 (also shown in FIG. 2B and partially shown in FIG.4A) that accommodates head portion 177 of interlocking blade 175, and anintramedullary rod plate hole 154 that allows passage of threaded shaftportion 156 through intramedullary rod plate 150 into threaded portion178 (from FIGS. 4A and 4B) of interlocking blade 175. In alternativeembodiments, cylindrical receiving part 152 and intramedullary rod platehole 154 may be eccentrically located in an intramedullary rod plate,rather than centrally located. In alternative embodiments, there may bemore than one eccentrically-located cylindrical receiving part 152 andcorresponding intramedullary rod plate hole 154, in which system therewould be two or more sites of attachment of an intramedullary rod plateto an intramedullary rod via two or more interlocking blades or otherfasteners.

Turning now to FIG. 5B, a perspective assembled view depictingintramedullary rod plate 150 secured to interlocking blade 175 withplate securing device 155 (from FIG. 5A) is shown, in accordance with anillustrative embodiment. Interlocking blade head 177 is shown seated incylindrical receiving part 152.

FIGS. 6A-6C are perspective views depicting the assembled intramedullaryrod plate system, with intramedullary rod plate 150 secured tointerlocking blade 175 that has been inserted through intramedullary rod100, with plate screws 160 placed through intramedullary rod plate 150,in accordance with illustrative embodiments. Turning now to FIG. 6A, aperspective view depicting the assembled intramedullary rod plate systemis shown, in accordance with an illustrative embodiment. Intramedullaryrod plate 150 is secured to interlocking blade 175 that has beeninserted through hole 101 (from FIG. 3A) in intramedullary rod 100, withplate screws 160 placed through holes 151 (from FIGS. 4A and 5A) inintramedullary rod plate 150. Plate screw heads 162 are depictedpressing into the screw holes 151 (from FIGS. 4A and 5A) ofintramedullary rod plate 150. Plate fixation device head 157 is shown,representing plate fixation device 155 (from FIGS. 4A, 4B, and 5A)securing intramedullary rod plate 150 to interlocking blade 175. Theperspective view in FIG. 6A depicts the lateral face of intramedullaryrod plate 150.

Turning now to FIG. 6B, a perspective view depicting the assembledintramedullary rod plate system is shown, in accordance with anillustrative embodiment. Intramedullary rod plate 150 is secured tointerlocking blade 175 that has been inserted through hole 101 (fromFIG. 3A) in intramedullary rod 100, with plate screws 160 placed throughthe intramedullary rod plate 150. The perspective view in FIG. 6Bdepicts the medial face of intramedullary rod plate 150.

Turning now to FIG. 6C, a perspective view depicting the assembledintramedullary rod plate system is shown, in accordance with anillustrative embodiment. Intramedullary rod plate 150 is secured tointerlocking blade 175, which has been inserted through hole 101 (fromFIG. 3A) in intramedullary rod 100, with plate screws 160 placed throughintramedullary rod plate 150. The perspective view in FIG. 6C depictsthe lateral face of intramedullary rod plate 150 as in FIG. 6A, but froma different perspective as in FIG. 6A.

Turning now to FIG. 7A, an end view depicting the assembledintramedullary rod plate system is shown, in accordance with anillustrative embodiment. Intramedullary rod plate 150 is secured tointerlocking blade 175 with plate securing device 155 (partially shownas represented by plate securing device head 157). Interlocking blade175 has been inserted through hole 101 (from FIG. 3A) in intramedullaryrod 100, with plate screws 160 placed through the intramedullary rodplate 150. Plate screw heads 162 and plate securing device head 157 arepartially visualized, having been inserted into and pressing againsttheir respective holes in intramedullary rod plate 150.

Turning now to FIG. 7B, a side or lateral view depicting the assembledintramedullary rod plate system is shown, in accordance with anillustrative embodiment. Intramedullary rod plate 150 is secured tointerlocking blade 175 (blade 175 not seen in this view because it isobscured by plate 150, see FIG. 7A) with plate securing device 155(partially shown as represented by plate securing device head 157).Interlocking blade 175 has been inserted through hole 101 (from FIG. 3A)in intramedullary rod 100 (not seen in this view, see FIGS. 6A-6C and7A), with plate screws 160 (not seen in this view because they areobscured by plate 150) represented by the visible plate screw heads 162placed through their corresponding holes in intramedullary rod plate150.

FIGS. 8A-8C depict an alternative embodiment of the intramedullary rodplate system. In this embodiment, a threaded interlocking bolt fastener(rather than an interlocking blade fastener as depicted in FIGS. 1-7) isused to attach an intramedullary rod plate to an intramedullary rod.Turning now to FIG. 8A, a top or anterior view depicting theintramedullary rod plate system in an assembled position is shown, inaccordance with an illustrative embodiment. In some embodiments, theintramedullary rod plate system includes intramedullary rod plate 150,plate screws 160, and plate securing device 155 (partially shown) thatsecures intramedullary rod plate 150 to threaded interlocking boltfastener 200 (henceforth referred to as an interlocking bolt 200).Intramedullary rod 300 has been inserted in a retrograde fashion intothe intramedullary canal of femur 105 in order to stabilize distal femurfracture 106. Fracture fixation distal to the fracture occurs bytransferring the bone fixation force achieved with screws 160 (that areinserted into distal femur bone) to intramedullary rod plate 150, whichin turn transfers this force to the intramedullary rod 300 through theattachment of interlocking bolt 200 to both the intramedullary rod plate150 and intramedullary rod 300. In comparison to the intramedullary rodplate system depicted in FIG. 1A, FIG. 8A depicts an interlocking bolt200 that extends through a corresponding hole in intramedullary rod 300by just enough length, approximately 2-5 millimeters, to secure bolt 200to rod 300. In contradistinction to the interlocking blade 175 that mayhave a frictional fit with bone and provide some stability as describedin FIG. 1A, interlocking bolt 200 would not be expected to have asignificant frictional fit with bone and therefore would not be expectedto itself confer additional stability to the fixation construct.Instead, interlocking bolt 200 would be expected to serve predominantlyas a method of attachment of intramedullary rod plate 150 tointramedullary rod 300. In alternative embodiments, interlocking bolt200 may be configured to extend a similar distance throughintramedullary rod 300 as interlocking blade 175 (from FIG. 1A) andachieve some frictional fit with bone, thereby imparting some additionalstability to the fixation construct.

Intramedullary rod fixation proximal to the fracture occurs via thefrictional fit of the outer surface of intramedullary rod 300 to thesurface of the medullary canal of femur 105. This proximal fixation maybe augmented by placing interlocking screws 165 or fasteners throughbone located towards the proximal end of the femur and through holes inthe intramedullary rod 300 at the end of the intramedullary rod oppositethe end of the rod with interlocking bolt 200 (e.g., proximal theinterlocking screws).

Referring now to FIG. 8B in conjunction with FIG. 8A, a side or lateralview depicting the intramedullary rod plate system in an assembledposition after retrograde insertion of the intramedullary rod 300 intothe intramedullary canal of a femur 105 in order to stabilize distalfemur fracture 106 is shown, in accordance with an illustrativeembodiment. Intramedullary rod plate 150 is secured to interlocking bolt200 (shown in FIG. 8A but not seen in FIG. 8B) by plate securing device155 (partially shown, the head 157 of plate securing device 155 is shownhere). In some embodiments, intramedullary rod plate 150 can includefour holes to accommodate four plate screws 160 (not shown, plate screwheads 162 are shown here, representing plate screws 160 as seen in FIG.8A). In alternative embodiments, intramedullary rod plate 150 caninclude more or fewer holes and can thus be used with more or fewer thanfour plate screws 160. In some embodiments, intramedullary rod plate 150may be pre-contoured or contoured intra-operatively to closely match thelocal bony anatomy. In this depiction, the terminal ends of the platescrews 160 (not shown here, shown in FIGS. 8A and 8C) are not visualizedbecause they are depicted as having been placed perpendicular to thelateral intramedullary rod plate surface, and so are hidden in this viewby intramedullary rod plate 150.

Intramedullary rod fixation proximal to the fracture occurs via thefrictional fit of the outer surface of the intramedullary rod 300 to thesurface of the medullary canal of femur 105. This proximal fixation maybe augmented by placing one or more interlocking screws 165 (asrepresented in this view by interlocking screw head 167) or fastenersthrough bone located towards the proximal end of the femur. The one ormore interlocking screws or fasteners are also placed through a hole orholes in the intramedullary rod 300 at the end of the intramedullary rodopposite the end of the rod with interlocking bolt 200 (e.g., proximalthe interlocking screws).

Referring now to FIG. 8C in conjunction with FIGS. 8A and 8B, a side orlateral view depicting the intramedullary rod plate system in anassembled position after retrograde insertion of the intramedullary rod300 into the intramedullary canal of the femur 105 in order to stabilizedistal femur fracture 106 is shown, in accordance with an illustrativeembodiment. Intramedullary rod plate 150 is secured to interlocking bolt200 (shown in FIG. 8A but not seen in FIG. 8C) by plate securing device155 (partially shown, the head 157 of plate securing device 155 is shownhere). In some embodiments, intramedullary rod plate 150 can includefour holes to accommodate four plate screws 160. In alternativeembodiments, intramedullary rod plate 150 can include more or fewerholes and can thus be used with more or fewer than four plate screws160. In some embodiments, intramedullary rod plate 150 may bepre-contoured or contoured intra-operatively to closely match the localbony anatomy. In this depiction, the terminal ends of the plate screws160 are visualized because they are shown as having been placedobliquely to the lateral intramedullary rod plate surface, divergentfrom the long axis of the intramedullary rod. The anterior-posterior andcephalad-caudal angle at which screws 160 can be inserted is determinedby the surgeon according to available intact femoral bone that can beemployed to achieve screw 160 purchase. The anterior-posterior andcephalad-caudal angle at which screws 160 can be inserted has manydegrees of freedom and is not limited by being required to pass throughholes in intramedullary rod 300, as is the case with conventionalintramedullary rod systems. Plate screw heads 162, which are part ofplate screws 160, are shown, as in FIG. 8B.

Turning now to FIG. 9A, a perspective view depicting the assembledintramedullary rod plate system is shown, in accordance with anillustrative embodiment. Intramedullary rod plate 150 is secured tointerlocking bolt 200 that has been inserted through reciprocal threadsin a hole 301 (see FIGS. 10A and 10B) in intramedullary rod 300, withplate screws 160 placed through intramedullary rod plate 150. Theterminal end 200 a of interlocking bolt 200 extends throughintramedullary rod 300 just enough distance to ensure fixation of bolt200 to rod 300. The bolt 200 does not have a frictional fit with distalfemur bone, as is described with interlocking blade 175 in FIG. 1A. Insome embodiments, interlocking bolt 200 serves predominantly as a methodof attachment of intramedullary rod plate 150 to intramedullary rod 300.In alternative embodiments, interlocking bolt 200 may be configured toextend a similar distance through intramedullary rod 300 as interlockingblade 175 (from FIG. 1A) to achieve some frictional fit with bone,thereby imparting some additional stability to the fixation construct.Plate fixation device head 157 is shown, representing plate fixationdevice 155 as shown in FIGS. 9B and 9C, and used for securingintramedullary rod plate 150 to interlocking bolt 200.

FIGS. 9B-9E depict assembly of interlocking bolt 200 with intramedullaryrod plate 150. Turning now to FIG. 9B, a perspective view depictinginterlocking bolt 200, intramedullary rod plate 150, and plate securingdevice 155 in an assembly position are shown, in accordance withillustrative embodiments. In some embodiments, interlocking bolt 200 caninclude a threaded shaft portion 201, and a head portion 202 with acentral threaded hole 203. In alternative embodiments, threaded shaftportion 201 can be configured as partially-threaded, with threadscovering sufficient length to mate with reciprocal threads in a hole 301(see FIGS. 10A and 10B) in intramedullary rod 300. Threaded hole 203 canaccommodate and mate with the threaded shaft portion 156 of platesecuring device 155. In some embodiments, intramedullary rod plate 150includes four holes 151 that can accommodate plate screws (160, shown inFIG. 2B) or fasteners. In some embodiments, intramedullary rod plate 150can include a central cylindrical receiving part 152 (partially shownhere, also shown in FIG. 2B and FIG. 5A and later in FIG. 9D) thataccommodates head portion 202 of interlocking bolt 200 on the medialside of the plate. The lateral side of the plate 150 is shown here, themedial side of the plate 150 is shown in FIG. 9D. The intramedullary rodplate 150 also includes a plate hole 154 that allows for passage ofthreaded shaft portion 156 of plate fastener 155 through intramedullaryrod plate 150 into threaded portion 203 of interlocking bolt 200. Insome embodiments, central hole 154 can include a laterally-facing sidewall 153 that accommodates the plate-facing medial surface of platesecuring device head 157 of plate securing device 155.

Now turning to FIG. 9C, a perspective assembled view depictingintramedullary rod plate 150 secured to interlocking bolt 200 with platesecuring device 155 (only the plate securing device head 157 is visible)is shown, in accordance with an illustrative embodiment.

Now turning to FIG. 9D, a perspective view depicting interlocking bolt200, intramedullary rod plate 150, and plate securing device 155 in anassembly position are shown, in accordance with illustrativeembodiments. FIG. 9B shows the lateral face of intramedullary rod plate150 and the relative configurations of interlocking bolt 200 and platesecuring device 155, whereas FIG. 9D shows the medial face ofintramedullary rod plate 150 and the relative configurations ofinterlocking bolt 200 and plate securing device 155. In someembodiments, interlocking bolt 200 can include a head portion 202, witha central threaded hole 203 (not shown here, shown in FIG. 9B) thatmates with threaded shaft portion 156 of plate securing device 155. Insome embodiments, intramedullary rod plate 150 includes four holes 151that can accommodate plate screws 160 (from FIG. 9A). In alternativeembodiments, intramedullary rod plate 150 can include fewer or more thanfour holes 151 that can accommodate plate screws 160 or other fasteners.In some embodiments, intramedullary rod plate 150 includes a centralcylindrical receiving part 152 (also shown in FIG. 2B and partiallyshown in FIG. 4A and FIG. 9B) that accommodates head portion 202 ofinterlocking bolt 200. The intramedullary rod plate 150 also includes anintramedullary rod plate hole 154 that allows passage of threaded shaftportion 156 of plate fastener 155 through intramedullary rod plate 150into threaded portion 203 (not shown here, shown in FIG. 9B) ofinterlocking bolt 200. In alternative embodiments, cylindrical receivingpart 152 and intramedullary rod plate hole 154 may be eccentricallylocated in an intramedullary rod plate, rather than centrally located.In alternative embodiments, cylindrical receiving part 152 andintramedullary rod plate hole 154 may be eccentrically located in anintramedullary rod plate, rather than centrally located. In alternativeembodiments, there may be more than one eccentrically-locatedcylindrical receiving part 152 and corresponding intramedullary rodplate hole 154, in which system there would be two or more sites ofattachment of an intramedullary rod plate to an intramedullary rod viatwo or more interlocking bolts.

Turning now to FIG. 9E, a perspective assembled view depictingintramedullary rod plate 150 secured to interlocking bolt 200 with platesecuring device 155 (not seen here, shown in FIG. 9B) is shown, inaccordance with an illustrative embodiment. Interlocking bolt head 202is shown seated in cylindrical receiving part 152. FIG. 9C shows thelateral face of intramedullary rod plate 150 and the relativeconfigurations of interlocking bolt 200 and plate securing device head157, whereas FIG. 9E shows the medial face of intramedullary rod plate150 and the relative configuration of interlocking bolt 200 (platesecuring device 155 and plate securing device head 157 are not seen inthis view).

FIGS. 10A-10D depict the assembly sequence of an embodiment of theintramedullary rod plate system. Now turning to FIG. 10A, a top viewdepicting one end of intramedullary rod 300, with interlocking bolt 200,intramedullary rod plate 150, plate securing device 155, and platescrews 160 are shown in an assembling position, in accordance withillustrative embodiments. Intramedullary rod 300 includes a threadedhole 301 (partially shown) that accommodates and fastens to the threadsof interlocking bolt 200. In an alternative embodiment, hole 301 may notbe threaded.

Now turning to FIG. 10B, a top view depicting one end of intramedullaryrod 300 now with interlocking bolt 200 threaded through hole 301 (fromFIG. 10A) is shown, in accordance with an illustrative embodiment.Interlocking bolt 200 includes a head portion 202, as also shown inFIGS. 9B and 9D, which fits into cylindrical receiving part 152(partially shown here, more fully shown in FIG. 9D). Intramedullary rodplate 150, plate securing device 155, and plate screws 160 are shown inan assembling position, in accordance with illustrative embodiments.

Now turning to FIG. 10C, a top view depicting one end of intramedullaryrod 300 with interlocking bolt 200 threaded through hole 301 (from FIG.10A), now with intramedullary rod plate 150 placed onto interlockingbolt head portion 202 (from FIG. 10B) is shown, in accordance with anillustrative embodiment. Plate securing device 155 and plate screws 160are shown in an assembling position, in accordance with illustrativeembodiments.

Now turning to FIG. 10D, a top view depicting one end of intramedullaryrod 300 with interlocking bolt 200 threaded through hole 301 (from FIG.10A) and intramedullary rod plate 150 placed onto interlocking bolt headportion 202 (from FIG. 10B) is shown in accordance with an illustrativeembodiment. In FIG. 10D, the plate securing device 155 (only the platesecuring device head 157 is visible) secures interlocking bolt 200 tointramedullary rod plate 150. Plate screws 160 are shown in anassembling position, in accordance with an illustrative embodiment.FIGS. 11A-11C will further depict the interaction amongst interlockingbolt 200, intramedullary rod plate 150, and plate securing device 155.

FIGS. 11A-11C depict perspective views of one embodiment of theassembled intramedullary rod plate system, in accordance with anillustrative embodiment. Now turning to FIG. 11A, a perspective viewdepicting one end of intramedullary rod 300 with interlocking bolt 200threaded through hole 301 (from FIG. 10A) and intramedullary rod plate150 placed onto bolt head portion 202 (from FIG. 10B) and plate securingdevice 155 (only the plate securing device head, 157 from FIG. 9B, isvisible) securing interlocking bolt 200 to intramedullary rod plate 150,with plate screws 160 passed through intramedullary rod plate 150 isshown, in accordance with an illustrative embodiment.

In FIG. 11B, an end view depicting intramedullary rod 300 withinterlocking bolt 200 inserted through hole 301 (from FIG. 10A) andintramedullary rod plate 150 placed onto bolt head portion 202 (fromFIG. 10B) is shown in accordance with an illustrative embodiment. Theplate securing device 155 (not seen in this view) secures interlockingbolt 200 to intramedullary rod plate 150, and plate screws 160 passthrough intramedullary rod plate 150. The terminal end 200 a ofinterlocking bolt 200 extends through intramedullary rod 300 just enoughdistance to ensure fixation of bolt 200 to rod 300. The bolt 200 doesnot have a significant frictional fit with distal femur bone, as isdescribed with interlocking blade 175 in FIG. 1A.

Now turning to FIG. 11C, a top view depicting one end of intramedullaryrod 300 with interlocking bolt 200 inserted through hole 301 (from FIG.10A) and intramedullary rod plate 150 placed onto bolt head portion 202(from FIG. 10B) is shown in accordance with an illustrative embodiment.The plate securing device 155 (only the plate securing device head, 157from FIG. 9B, is visible) secures interlocking bolt 200 tointramedullary rod plate 150, and plate screws 160 pass throughintramedullary rod plate 150.

FIGS. 12A-12C depict the assembly sequence of an alternative embodimentof the intramedullary rod plate system. In this embodiment, aninterlocking screw (rather than an interlocking blade as depicted inFIGS. 1-7, or an interlocking bolt as depicted in FIGS. 8-11) is used toattach an intramedullary rod plate to an intramedullary rod. Now turningto FIG. 12A, a perspective view depicting intramedullary rod 400, withinterlocking screw fastener 225 (henceforth referred to as aninterlocking screw 225), intramedullary rod plate 250, and plate screws160 is shown in an assembling position, in accordance with illustrativeembodiments. In some embodiments, interlocking screw 225 includesthreaded shaft portion 226 and head portion 227. In alternativeembodiments, interlocking fastener 225 may have a smooth oralternatively contoured surface that is configured to form a connectionwith rod 400. In some embodiments, intramedullary rod 400 includes ahole 401 (hole 401 on the lateral side of the rod is shown, and there isa corresponding hole directly opposite the visible hole 401, e.g., onthe medial side of the rod) that accommodates interlocking screw 225.Hole 401 may include threads that mate with the threaded portion 226 ofinterlocking screw 225, or hole 401 may be thread-less, in which case insome embodiments the relationship between hole 401 and threaded shaftportion 226 creates an interference frictional fit between the threadsof interlocking screw shaft 226 and the surface of hole 401. In someembodiments, intramedullary rod plate 250 includes four holes 251 thatcan accommodate plate screws 160. In alternative embodiments,intramedullary rod plate 250 can include fewer or more than four holes251 that can accommodate plate screws 160 or other fasteners. In someembodiments, intramedullary rod plate 250 includes plate hole 254 thatallows for passage of threaded portion 226 of interlocking screw 225through plate hole 254. The medial surface of head portion 227 may beconfigured to engage with the lateral surface of plate hole 254, thusachieving an interference frictional fit of interlocking screw head 227with intramedullary plate 250. In alternative embodiments, the medialsurface of head portion 227 may be configured with threads that engageand mate with a threaded lateral surface of plate hole 254, thuscreating a locked threaded engagement.

In alternative embodiments, plate hole 254 may be eccentrically locatedin an intramedullary rod plate, rather than centrally located. Inalternative embodiments, there may be more than oneeccentrically-located plate hole 254, in which system there would be twoor more sites of attachment of an intramedullary rod plate to anintramedullary rod via two or more interlocking screws.

Now turning to FIG. 12B, a perspective view depicting interlocking screw225 now inserted through intramedullary rod plate 250 (through hole 254from FIG. 12A) and through hole 401 in intramedullary rod 400 is shown,in accordance with an illustrative embodiment. Plate screws 160 areshown in an assembling position. Hole 401 may include threads that matewith the threaded portion 226 of interlocking screw 225, or hole 401 maybe thread-less, in which case in some embodiments the relationshipbetween hole 401 and threaded shaft portion 226 would be configured tocreate an interference frictional fit between the threads ofinterlocking screw shaft 226 and the surface of hole 401. Head portion227 of interlocking screw 225 engages intramedullary rod plate 250 byvirtue of the medial-facing surface of head portion 227 (from FIG. 12A)pressing tightly against the lateral-facing surface of plate hole 254(from FIG. 12A). As the medial-facing surface of head portion 227presses tightly against the lateral-facing surface of plate hole 254,the medial surface of intramedullary rod plate 250 is pressed againstthe outer surface of distal femur 300 (from FIGS. 1A and 8A). Asinterlocking screw 225 is advanced into femoral bone and achieves africtional fit with bone, intramedullary rod plate 250 is furtherpressed against the outer surface of distal femur 300 (from FIGS. 1A and8A), thus creating a frictional force between both the screw head 227and plate 250 as well as a frictional force between both the plate 205and the outer surface of the distal femur, until the perceived level ofscrew purchase and frictional force are achieved. This interaction offrictional forces amongst interlocking screw 225, intramedullary rodplate 250, intramedullary rod 400, and femoral bone would create arelatively rigid connection between intramedullary rod plate 250 andintramedullary rod 400, thus allowing for bone fixation using screws160, as depicted in FIG. 12C.

Though it is not shown here, intramedullary rod fixation proximal to thefracture occurs via the mechanism described in FIG. 8A. With referenceto FIG. 8A, intramedullary rod fixation proximal to the fracture occursvia the frictional fit of the outer surface of intramedullary rod 400 tothe surface of the medullary canal of femur 105, and this proximalfixation may be augmented by placing interlocking screws 165 orfasteners through bone located towards the proximal end of the femur andthrough holes in the intramedullary rod 400 at the end of theintramedullary rod opposite the end of the rod with interlocking screw225 (e.g., proximal interlocking screws).

Now turning to FIG. 12C, a perspective view depicting interlocking screw225 inserted through intramedullary rod plate 250 (through hole 254 fromFIG. 12A) and through hole 401 (from FIG. 12A) in intramedullary rod400, with plate screws 160 now inserted through intramedullary rod plate250 is shown, in accordance with an illustrative embodiment. Headportion 227 of interlocking screw 225 engages intramedullary rod plate250 by virtue of the medial-facing surface of head portion 227 pressingtightly against the lateral-facing surface of plate hole 254 (from FIG.12A). As the medial-facing surface of head portion 227 presses tightlyagainst the lateral-facing surface of plate hole 254 (from FIG. 12A),the medial surface of intramedullary rod plate 250 is pressed againstthe outer surface of distal femur 300 (from FIGS. 1A and 8A). Asinterlocking screw 225 is advanced into femoral bone and achieves africtional fit with bone, intramedullary rod plate 250 is furtherpressed against the outer surface of distal femur 300 (from FIGS. 1A and8A), thus creating a frictional force between both the interlockingscrew head 227 and plate 250, as well as a frictional force between boththe plate 205 and the outer surface of the distal femur, until theperceived level of screw purchase and frictional force are achieved.This interaction of frictional forces amongst interlocking screw 225,intramedullary rod plate 250, intramedullary rod 400, and femoral bonecreates a relatively rigid connection between intramedullary rod plate250 and intramedullary rod 400, thus allowing for bone fixation usingscrews 160. Screws 160 are inserted through plate holes 251 (from FIG.12A) and threaded screw shafts 162 achieve a frictional fit with bone.As the screws 160 are inserted fully and screw heads 162 press tightlyinto plate holes 251 (from FIG. 12A) to achieve a frictional fit withintramedullary rod plate 250, fixation of the intramedullary rod platesystem to bone distal to the femur fracture 106 (from FIGS. 1A and 8A)is achieved.

Turning now to FIG. 13A, a top view depicting an embodiment of theassembled intramedullary rod plate system is shown in accordance with anillustrative embodiment. Intramedullary rod plate 250 is secured tointerlocking screw 225 via either a frictional fit or threadedengagement with interlocking screw head 227, and interlocking screw 225has been inserted through intramedullary rod 400. Plate screws 160 areplaced through holes 251 (from FIG. 12A) in intramedullary rod plate250. Only two plate screws 160 are visible in this view because the twoscrews in the forefront overlap the two screws in the background. In analternative embodiment, more or fewer screws 160 may be inserted throughholes in an intramedullary rod plate.

Turning now to FIG. 13B, a top perspective view depicting the assembledintramedullary rod plate system is shown in accordance with anillustrative embodiment. Intramedullary rod plate 250 is secured tointerlocking screw 225 via either a frictional fit or threadedengagement with interlocking screw head 227. The interlocking screw 225has been inserted through intramedullary rod 400, with plate screws 160placed through holes 251 (from FIG. 12A) in intramedullary rod plate250.

Now turning to FIG. 14A, a perspective view depicting the assembledintramedullary rod plate system is shown in accordance with anillustrative embodiment. Intramedullary rod plate 250 is secured tointerlocking screw 225 via either a frictional fit or threadedengagement with interlocking screw head 227. The interlocking screw 225has been inserted through intramedullary rod 400, with plate screws 160placed through holes 251 (from FIG. 12A) in intramedullary rod plate250.

FIG. 14B is a perspective view depicting the assembled intramedullaryrod plate system in accordance with an illustrative embodiment.Intramedullary rod plate 250 is secured to interlocking screw 225 viaeither a frictional fit or threaded engagement with interlocking screwhead 227. The interlocking screw 225 has been inserted throughintramedullary rod 400, with plate screws 160 placed through holes 251(from FIG. 12A) in intramedullary rod plate 250.

FIG. 15 is a flow diagram depicting operations performed to use anintramedullary rod plate system in accordance with an illustrativeembodiment. In alternative embodiments, fewer, additional, and/ordifferent operations may be performed. Also, the use of a flow diagramis not meant to be limiting with respect to the order of operationsperformed. In an operation 1500, an intramedullary rod is placed into afractured bone. The intramedullary rod is placed into a medullary canalof the bone through an incision in the skin, and in accordance withtechniques known to those of skill in the art. In an illustrativeembodiment, the intramedullary rod spans a fracture in the bone suchthat a proximal end of the intramedullary rod is proximal to thefracture and a distal end of the intramedullary rod is distal to thefracture.

In an operation 1505, the proximal end of the intramedullary rod issecured to a proximal end of the bone. The proximal end can be securedby placing a screw or other fastener through the bone and into a hole inthe proximal end of the intramedullary rod. Imaging may be used to placethe screw or other fastener. In an operation 1510, an intramedullary rodplate is placed proximate to the distal portion of the fractured bonethrough an incision in the skin. Placement of the intramedullary rodplate may be assisted with the use of imaging.

In an operation 1515, the intramedullary rod plate is secured to theintramedullary rod with a first fastener. In one embodiment, the firstfastener can be a blade. Alternatively, a bolt, screw, or other type offastener may be used. In an illustrative embodiment, the first fastenerincludes a cylindrical head that is received by a cylindrical protrusionon a rear face of the intramedullary rod plate. In an operation 1520,the first fastener is secured to the intramedullary rod plate. In oneimplementation, an opening in the intramedullary rod plate that receivesthe first fastener is chamfered such that a head of a first fastenersecuring screw mates with the chamfered opening. The first fastenersecuring screw is threaded into the cylindrical head of the firstfastener such that the first fastener is secured to the intramedullaryrod plate. In an operation 1525, the intramedullary rod plate is securedto the fractured bone with one or more additional fasteners that travelthrough openings into the intramedullary rod plate and into the bone.Screws or any other type of fastener(s) may be used in operation 1525.

The embodiments described herein are not limited to use of a singleintramedullary rod plate. For example, in one embodiment, theintramedullary rod plate system utilizes two intramedullary rod plateswith a single rod to immobilize a fracture. In such an embodiment, afirst intramedullary rod plate is positioned and mounted distal to thefracture as described herein. A second intramedullary rod plate ispositioned and mounted proximal to the fracture using the same process.In an alternative embodiment, a single intramedullary rod plate may beused, and may be positioned and mounted proximal to the fracture. Thedecision regarding whether to use a single intramedullary rod plate(either proximal or distal to the fracture) or two intramedullary rodplates (one proximal and one distal) can be made during surgerydepending on the clinical circumstances. In another alternativeembodiment, a single, larger plate can be used which spans the fractureand which is secured to the bone and intramedullary rod both proximaland distal to the fracture.

The components (e.g., the intramedullary rod plate, intramedullary rod,interlocking fasteners, plate screws, and plate fasteners) describedherein may be made in a variety of lengths and/or shapes to accommodatevarious patient anatomies and surgeon preferences. The components can bemade from a variety of biologically compatible materials suitable formedical applications, including but not limited to metals, bonematerial, ceramics, and synthetic composites. For example, thecomponents of a intramedullary rod plate system may be fabricated frommaterials such as titanium, titanium alloys, cobalt-chrome alloys,stainless steel, stainless steel alloys, thermoplastics such aspolyether ether ketone (PEEK) and other similar substances, carbonfiber, carbon fiber composites, ceramics and composites, aluminum,allograft bone, xenograft bone, any combination of the above substances,or any suitable material that is able to withstand the biomechanicalstresses under which they are placed.

The herein described subject matter sometimes illustrates differentcomponents contained within, or connected with, different othercomponents. It is to be understood that such depicted architectures aremerely examples, and that in fact many other architectures can beimplemented which achieve the same functionality. In a conceptual sense,any arrangement of components to achieve the same functionality iseffectively “associated” such that the desired functionality isachieved. Hence, any two components herein combined to achieve aparticular functionality can be seen as “associated with” each othersuch that the desired functionality is achieved, irrespective ofarchitectures or intermedial components. Likewise, any two components soassociated can also be viewed as being “operably connected,” or“operably coupled,” to each other to achieve the desired functionality,and any two components capable of being so associated can also be viewedas being “operably couplable,” to each other to achieve the desiredfunctionality. Specific examples of operably couplable include but arenot limited to physically mateable and/or physically interactingcomponents and/or wirelessly interactable and/or wirelessly interactingcomponents and/or logically interacting and/or logically interactablecomponents.

With respect to the use of substantially any plural and/or singularterms herein, those having skill in the art can translate from theplural to the singular and/or from the singular to the plural as isappropriate to the context and/or application. The varioussingular/plural permutations may be expressly set forth herein for sakeof clarity.

It will be understood by those within the art that, in general, termsused herein, and especially in the appended claims (e.g., bodies of theappended claims) are generally intended as “open” terms (e.g., the term“including” should be interpreted as “including but not limited to,” theterm “having” should be interpreted as “having at least,” the term“includes” should be interpreted as “includes but is not limited to,”etc.). It will be further understood by those within the art that if aspecific number of an introduced claim recitation is intended, such anintent will be explicitly recited in the claim, and in the absence ofsuch recitation no such intent is present. For example, as an aid tounderstanding, the following appended claims may contain usage of theintroductory phrases “at least one” and “one or more” to introduce claimrecitations.

However, the use of such phrases should not be construed to imply thatthe introduction of a claim recitation by the indefinite articles “a” or“an” limits any particular claim containing such introduced claimrecitation containing only one such recitation, even when the same claimincludes the introductory phrases “one or more” or “at least one” andindefinite articles such as “a” or “an” (e.g., “a” and/or “an” shouldtypically be interpreted to mean “at least one” or “one or more”); thesame holds true for the use of definite articles used to introduce claimrecitations. In addition, even if a specific number of an introducedclaim recitation is explicitly recited, those skilled in the art willrecognize that such recitation should typically be interpreted to meanat least the recited number (e.g., the bare recitation of “tworecitations,” without other modifiers, typically means at least tworecitations, or two or more recitations).

Furthermore, in those instances where a convention analogous to “atleast one of A, B, and C, etc.” is used, in general such a constructionis intended in the sense one having skill in the art would understandthe convention (e.g., “a system having at least one of A, B, and C”would include but not be limited to systems that have A alone, B alone,C alone, A and B together, A and C together, B and C together, and/or A,B, and C together, etc.). In those instances where a conventionanalogous to “at least one of A, B, or C, etc.” is used, in general sucha construction is intended in the sense one having skill in the artwould understand the convention (e.g., “a system having at least one ofA, B, or C” would include but not be limited to systems that have Aalone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.).

It will be further understood by those within the art that virtually anydisjunctive word and/or phrase presenting two or more alternative terms,whether in the description, claims, or drawings, should be understood tocontemplate the possibilities of including one of the terms, either ofthe terms, or both terms. For example, the phrase “A or B” will beunderstood to include the possibilities of “A” or “B” or “A and B.”Further, unless otherwise noted, the use of the words “approximate,”“about,” “around,” “substantially,” etc., mean plus or minus tenpercent.

The foregoing description of illustrative embodiments has been presentedfor purposes of illustration and of description. It is not intended tobe exhaustive or limiting with respect to the precise form disclosed,and modifications and variations are possible in light of the aboveteachings or may be acquired from practice of the disclosed embodiments.It is intended that the scope of the disclosure be defined by the claimsappended hereto and their equivalents.

1. A system to stabilize a fracture, the system comprising: anintramedullary rod having a first end and a second end and configuredfor placement within a medullary bone canal of a bone, wherein theintramedullary rod includes a first rod hole at the second end; anintramedullary rod plate having a first plate hole and a second platehole, wherein the intramedullary rod plate includes a cylindricalreceiving part on an inner surface thereof, and wherein the cylindricalreceiving part is aligned with the first plate hole; a first fastenerthat includes a head portion, wherein the head portion is configured tobe received by the cylindrical receiving part such that the head portionis maintained on the inner surface of the intramedullary rod plate,wherein the first fastener passes through an outer surface of the boneand through the first rod hole at the second end of the intramedullaryrod such that the first fastener secures the intramedullary rod plate tothe intramedullary rod; and a second fastener configured to pass throughthe second plate hole and into the bone such that the second fastenersecures the intramedullary rod plate to the bone.
 2. (canceled)
 3. Thesystem of claim 1, wherein the head portion of the first fastenerincludes a threaded opening, and further comprising a plate securingdevice having a threaded portion that is configured to mate with thethreaded opening of the first fastener to secure the first fastener tothe plate securing device.
 4. The system of claim 3, further comprisinga chamfer on an outer surface of the intramedullary rod plate, whereinthe chamfer surrounds the first plate hole.
 5. The system of claim 4,wherein the plate securing device includes a plate securing device headthat is configured to mate with the chamfer such that the plate securingdevice is unable to pass through first plate hole.
 6. The system ofclaim 3, wherein the plate securing device secures the intramedullaryrod plate to the first fastener when the plate securing device isthreaded into the head portion of the first fastener.
 7. (canceled) 8.The system of claim 1, wherein the first fastener comprises aninterlocking bolt, wherein the first rod hole is threaded and configuredto mate with threads on the interlocking bolt.
 9. The system of claim 1,further comprising a contour on an inner surface of the intramedullaryrod plate, wherein the contour is configured to mate with an outersurface of the bone.
 10. The system of claim 1, wherein the first platehole is located in a center of the intramedullary rod plate.
 11. Thesystem of claim 1, wherein the first plate hole is located eccentricallyin the intramedullary rod plate.
 12. The system of claim 1, furthercomprising a third plate hole configured to receive a third fastener, afourth plate hole configured to receive a fourth fastener, and a fifthplate hole configured to receive a fifth fastener, wherein the thirdfastener, the fourth fastener, and the fifth fastener are configured topass through the outer surface of the bone to secure the intramedullaryrod plate to the bone.
 13. The system of claim 1, wherein theintramedullary rod includes a second rod hole at the first end, whereinthe second rod hole is configured to receive a third fastener to securethe intramedullary rod to the bone.
 14. A method of stabilizing afracture, the method comprising: placing an intramedullary rod having afirst end and a second end into a medullary bone canal of a bone,wherein the intramedullary rod includes a first rod hole at the secondend; placing an intramedullary rod plate proximate to the second end ofthe intramedullary rod, wherein the intramedullary rod plate includes afirst plate hole and a second plate hole, wherein the intramedullary rodplate includes a cylindrical receiving part on an inner surface thereof,and wherein the cylindrical receiving part is aligned with the firstplate hole; placing a head of a first fastener in into the cylindricalreceiving part such that the head of the first fastener is maintained onthe inner surface of the intramedullary rod plate, and furthercomprising passing a body of the first fastener through an outer surfaceof the bone, and through the first rod hole at the second end of theintramedullary rod to secure the intramedullary rod plate to theintramedullary rod; and placing a second fastener through the secondplate hole and into the bone to secure the intramedullary rod plate tothe bone.
 15. The method of claim 14, wherein the head portion of thefirst fastener includes a threaded opening, and further comprisingsecuring the first fastener with a plate securing device, wherein theplate securing device has a threaded portion that is configured to matewith the threaded opening in the head of the first fastener.
 16. Themethod of claim 15, wherein securing the first fastener with the platesecuring device includes mating a plate securing device head of theplate securing device with a chamfer that surrounds the first plate holesuch that the plate securing device is unable to pass through the firstplate hole.
 17. The method of claim 14, further comprising placing athird fastener through a second rod hole at the first end of theintramedullary rod to secure the first end of the intramedullary rod tothe bone.
 18. The method of claim 14, wherein the first fastenercomprises an interlocking bolt, and wherein securing the first fastenerto the first rod hole comprises mating threads of the interlocking boltwith threads in the first rod hole.
 19. (canceled)
 20. The method ofclaim 14, wherein placing the intramedullary rod plate comprises matinga contour on an inner surface of the intramedullary rod plate with anouter surface of the bone.
 21. The system of claim 1, wherein thecylindrical receiving part includes an opening that is larger than thefirst plate hole, and wherein the cylindrical receiving part is alignedwith the first plate hole such that a portion of the inner surface ofthe intramedullary rod plate surrounding the first plate hole forms alip.
 22. The system of claim 21, wherein the head portion of the firstfastener contacts the lip such that the head portion is maintained onthe inner surface of the intramedullary rod plate.